You Are What You Eat – The 2015 Dietary Guidelines for Americans

Many Americans, at one point or another, have probably heard about the “food pyramid” and know that it has something to do with what the government says makes up a healthy diet. But have you ever wondered where those federal food and nutrition guidelines actually come from, or what information they’re based on, or just who gets to decide what is “healthy” for everyone?

The United States Department of Agriculture’s (USDA) Center for Nutrition Policy & Promotion (CNPP) is responsible for the general nutritional guidelines for Americans. The most recent nutritional icon, called “MyPlate,” was released on June 2, 2011 by First Lady Michelle Obama and USDA Secretary Tom Vilsack and replaced the previous “MyPyramid” model. The visual guide features a colourful plate divided into approximate portions for fruits, vegetables, grains, protein and dairy. The dinner table imagery is meant to help children, parents, and other adults prioritize their food choices at meal times to include all of the groups listed, as well as consume them in proportions relative to each other (e.g. half a plate of fruits and veggies) as a model diet to promote good health.

The nutritional recommendations behind the simpler MyPlate came from the 2010 Dietary Guidelines for Americans (DGA), a policy document jointly produced by the USDA’s CNPP and the United States Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion. Since the publication of the first edition in 1980, the Guidelines have been updated every five years to reflect the most current knowledge on health and nutrition. A Dietary Guidelines Advisory Committee (DGAC), made up of 13 to 17 nationally recognized experts in the field of health and nutrition, meets in the year prior to each update to discuss what should be included, removed, or revised in the guidelines by conducting a thorough review of scientific and medical literature, as well as soliciting comments from the public. A scientific report is written and delivered to Secretaries of the USDA and HHS containing the DGAC’s recommendations for the next edition. The next revision to the guidelines is currently in process, with the final report due to the USDA and HHS by early 2015.

As with any guide that tries to cater to a population as large and diverse as the American public, MyPlate and the Dietary Guidelines are not without disagreements and multiple opinions. Everyone likes to think that how they eat is “healthy” – be it vegetarian, fruitarian, vegan, gluten-free, dairy-free, carnivore, paleo, primal, veggie-free, or what-have-you. In addition, MyPlate has been criticized for removing a reference to physical activity, another important contributor to good health, which was present on the MyPyramid icon as a person climbing stairs.

While some people might be of the opinion that what the federal government says is “good food” and “healthy” isn’t all that important (because they’re going to eat however they want anyway), the Dietary Guidelines for Americans does play an important role in public health. In addition to consisting of guidelines for the general public’s own consumption, the DGA is a policy document that is used to set policy related to nutrition within the government. In the USDA, the dietary guidelines are used to set standards for school lunch and other feeding programs such as Supplemental Nutrition Assistance Program (SNAP) and Women Infants and Children (WIC) program. Within HHS, the DGA is used by parts of the National Institutes of Health (NIH) to produce consumer information materials supporting healthy lifestyles for various diseases (such as hypertension), while the Food and Drug Administration (FDA) uses parts of the DGA as the basis for the Nutrition Facts information guides found on all packaged food. Thus, it is important that the final DGA and the recommendations made by the DGAC are firmly based on rational, scientific facts and arguments and are not unduly influenced by groups with their own interests at heart.

This influential effect on other governmental policies is what makes the content of the DGA itself very political. It seems that every step forward in terms of recommendations based solely on scientific evidence for advancing optimal human health, is met head on by opposition from groups with powerful incentives to make money and/or preserve a status quo. As one example, it is likely that the 2015 DGA will include a recommendation that sugar be limited to no more than 10% of a person’s daily calories. All previous editions of the DGA have not included a recommendation for an upper limit on daily sugar consumption, which is why there is no number for % daily value (%DV) for sugar on any food product nutrition label. Meanwhile, the World Health Organization (WHO) is currently in the process of updating their guidelines on sugar consumption. This guidance, expected to be published in early 2015, suggests that a reduction in sugar consumption from less than 10% of total energy intake per day (the current 2002 guideline) to below 5% would have additional health benefits on body mass and tooth decay. For an average adult, the 5% mark would be equivalent to approximately 25 g of sugar per day or less. The American public currently consumes an average of 126 g of sugar per day, with much of that coming from added sugars in processed foods, and specifically, from sweetened beverages. Success in this one single area – reducing American’s consumption of sugar-sweetened beverages – could have a significant impact on the overall health and body mass of Americans. Not surprising, the beverage industry has issued some pushback for the inclusion of any specific limits on added dietary sugar (among other concerns) in the newest DGA. The American Beverage Association has submitted public comments for the DGA, suggesting that the WHO-commissioned review lacked scientific evidence and that the setting of Dietary Reference Intakes (DRIs) is not the responsibility of the DGAC and therefore should be done by other organizations. Similar arguments have been made by the Grocery Manufacturers Association, the Juice Products Association, the National Council of Farmer Cooperatives and the Sugar Association among others.

Other groups have tried to take the politics out of what we should eat and focus just on what the science of nutrition says. “Unfortunately, like the earlier U.S. Department of Agriculture pyramids, MyPlate mixes science with the influence of powerful agricultural interests, which is not the recipe for healthy eating,” said Walter Willett, professor of epidemiology and nutrition and chair of the Department of Nutrition at the Harvard School of Public Health (HSPH)1. HSPH released its own version of MyPlate known as the “Healthy Eating Plate”. This plate featured even more vegetables compared to fruit, an even split between grains and healthy protein, an emphasis on drinking water over dairy, and indicated that healthy oils should also be consumed. It also included a direction to “Stay Active” as a part of a healthy lifestyle. The goal of the Healthy Eating Plate is to give more specific information for a healthy diet in a way that is as clear and intuitive to follow as the MyPlate icon, without influence from the food industry or agricultural policies.

What one eats (and what one does) on a daily basis has a profound impact on one’s overall health and quality of life. “One of the most important fields of medical science over the past 50 years is the research that shows just how powerfully our health is affected by what we eat. Knowing what foods to eat and in what proportions is crucial for health,” said Anthony Komaroff, a professor of medicine at Harvard Medical School and editor in chief of Harvard Health Publications1. It will be interesting to see what the recommendations for the 2015 update to the Dietary Guidelines are and what recommendations actually make it into the final document. At the end of the day, what you choose to eat is up to you. However, everyone is entitled to accurate information about the health consequences of their personal food choices. Regardless of how you eat or what diet you follow, we are all human and the basic principles for good health and longevity remain the same for everyone. Like it or not, you are what you eat.

Regardless of if you have faith in the USDA to provide healthful information (which I don’t), it could be argued that the government has no place analyzing research and disseminating this information to the public. At best, it’s useless and can easily be ignored. At worst, it’s misleading and could possibly induce harm to people who attempt to follow their recommendations.

[…] Every five years, the nutritional recommendations that help Americans make healthy dietary choices are revised to reflect the current state of nutritional and health science. Although only 4% of Americans adhere to these Dietary Guidelines for Americans (DGAs), DGAs have a huge impact. For example, physicians routinely use them to advise patients on how to stay healthy. DGAs also affect billions of dollars in government spending as they inform meal content for military personnel, those helped through the Women, Infants and Children (WIC) program and the Supplemental Nutrition Assistance Program (SNAP), and US children who are served public school lunches. […]